Respiratory 28 Allergen Panel
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Respiratory 28 Allergen Panel | |
| 2. | |
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| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
RSPP
Test Workstation :
MAYO
Specimen Type:
Blood
Tube Type:
Red top ( no anticoagulant) tube
Collection Volume:
9.0 mL
Minimum Volume:
7.5 mL
Storage:
Refrigerated
Availability:
Sent to Mayo Medical Laboratory
Methodology:
Fluorescence Enzyne Immunoassay ( FEIA)
Lab/Phone:
330-543-8418
TAT:
1-3 days
Additional Info:
Reference range is available on patient report
CPT Code:
86003
Panel Includes:
Cat Epithelium IgE, Short Ragweed IgE, Mountain Cedar IgE, Elm IgE, Oak IgE, Silver Birch IgE, Russian Thistle IgE, Cockroach IgE, Rough Marsh Elder IgE, White Hickory IgE, Easter Sycamore IgE, Rough Pigweed IgE, White Ash IgE, Walnut IgE, Nettle IgE, Red Sorrel IgE, Cottonwood IgE, Mulberry IgE, Boxelder-Maple IgE, Timothy Grass IgE, Bermuda Grass igE, House Dust Mites/D.P. IgE, House Dust Mites/D.F. IgE, Alternaria Tenuis IgE, Aspergillus Fumigatus IgE, Cladosporium IgE, Penicillium IgE, Dog Dander IgE
